Exam 5 Flashcards
what lies in retroperitoneal space?
kidneys, ureters
what lies in infraperitoneal space?
bladder, urethra
Which kidney is lower?
R, bc of liver
kidneys lie at what vertical angle to the MSP?
20º
which kidney pole is closer to the midline?
upper
which kidney border is more ant? (med./lat.)
med.
kidneys lie at what angle to MCP?
30º
30º LPO for IVP shows what?
L kidney and ureter, with the R kidney in profile (II to IR)
kidneys are normally located midway btw?
xiphoid process and iliac crest
top of L kidney at what level?
T11/12
bottom of R kidney at what level?
L3
which are more anterior? renal veins or arteries?
renal veins anterior to renal arteries
average urine produced in 24 hours?
1.5 L
what is composed of 8-18 conical masses? and what are those conical masses called?
medulla; renal pyramids
apex of renal pyramid (that drains into minor calyces)?
renal papilla
urine is formed where?
in nephron
nephron?
structural and functional unit; 1 million per kidney
nephron is made up of what?
glomerulus and long tubules
filtrate from the collecting tubule flows to where?
minor calyx
what is located within the kidney cortex?
glomeruli, glomerulus capsules, PCT/DCT of nephrons
what is located w/in kidney medulla?
loop of henle & collecting tubules
ureters lie anterior to what?
psoas major mm
ureters enter what portion of bladder?
posterolateral
ureter diameter?
1mm-1cm
kidney stones most commonly get stuck at which constrictive point?
UVJ
mucosa of trigone? the rest of bladder?
smooth; rugae
urine amount that causes desire to void?
250 mL
total capacity of bladder?
350-500 mL
rectum full of feces pushes the bladder how?
up and forward
female urethra length?
4 cm
male urethra length?
17.5 - 20 cm
what controls rate of bolus injection?
needle gauge, injection amount, contrast viscosity, vein stability, and injection force
what controls drip infusion?
clamp device
syncope
feinting/loss of consciousness
why are antecubital fossa veins preferred?
larger and easy to access
antecubital fossa veins include what 3 veins?
median cubital, cephalic, and basilic veins
what veins should tech avoid?
sclerotic, tortuous, overused, area of vein bifurcation, veins directly over arteries
size of needle determined by what?
size of vein
where do you place tourniquet?
3-4” above injection site
for venipuncture approach vein at what angle?
20-45º
you should observe what when securing a butterfly needle?
back flow of B
contrast w salt as cation?
ionic
contrast that creates a hypertonic condition?
ionic
contrast w high osmolality?
ionic
contrast w low osmolality?
nonionic
isotonic contrast?
nonionic
contrast that remains intact when injected?
nonionic
expensive contrast?
nonionic
Low Osmolality Organic Iodide contrast?
ionic contrast w nonionic characteristic (less dose required, less adverse reactions)
2 common side effects of contrast?
temp hot flashes, metallic taste
normal creatinine levels?
0.6 - 1.5 mg/dL
normal BUN levels?
8 - 25 mg/100 mL
metformin must be withheld at least how long long after exam?
48 hrs
2 local reactions to contrast?
extravasation and phlebitis (vein inflammation)
categories of systemic reactions?
mild (nonallergic), moderate (anaphylactic), severe (vasovagal reaction)
urticaria?
moderate-severe hives (moderate systemic reaction to contrast)
severe hypotension?
systolic BP < 80 mm Hg
severe bradycardia?
< 50 bpm
contrast reaction may not be identifiable for up to how long?
48 hrs
what must you do before IVU?
void bladder, clamp foley catheter
IVU is what kind of study?
f(x)al
pt’s w what 2 disorders are at a particularly high risk when performing IVUs?
multiple myeloma (bone tumor) & pheochromocytoma (adrenal medulla tumor)
what can be done to pt’s before exam to help reduce risks to high-risk pt’s?
hydration therapy, normal saline IV drip, and diuretic (+ urine)
bladder carcinoma
tumor that’s 3x’s more common in males
most common urinary congenital abnormality?
duplication of ureter and renal pelvis
95% of fusion of horeshoe kidneys occur at which poles?
lower
cystisis
bladder inflammation more common in females
most common cause of enlarged kidneys?
polycystic kidney disease; appears as a “bunch of grapes” scattered throughout kidney
IVU pt prep?
NPO 8 hr, void bladder, clamp foley
ureteric compression?
to enhance filling and allow renal collecting system to retain contrast longer
when do you inflate ureteric compression paddles?
after injection of contrast
alt. to ureteric compression?
15º trendelenberg - similar results, less risks
IVU protocol?
KUB scout, 45s-1min nephrogram, 5-, 10-, 15-min AP supine, 20min 30º LPO/RPO, postvoid (prone/erect)
prolapsed bladder or enlarged prostate best confirmed…?
in erect pos
nephrogram shows what?
renal parenchyma blush w contrast
retrograde urography is what kind of study?
nonfunctional exam done in OR by urologist to determine location of obstructions
contrast flows into cystogram by what?
gravity! (only!)
VCU is what kind of study?
f(x)al
VCU projection for female?
AP
VCU projection for male?
30º RPO
nuclear med good for showing?
signs of organ rejection
CR for AP Cystography?
CR 10-15º caudad to 2” sup. to pubic symphysis
rotation for obl pos’s of cystography?
45-60º
CR for post obl cystography?
perp to 2” sup. to pubic symphysis and 2” med. to ASIS
CR for lat cystography?
(w pb shield behind pt) perp to 2” sup. and post. to pubic symphysis
CR for VCU?
perp to pubic symphysis (AP female, 30º RPO male)
what is important before VCU?
remove foley catheter
renal cysts and adrenal masses are demonstrated during which phase of IVU?
nephrogram
larger exposure angle in tomography produces what kind of sections?
thinner
most common exposure angle for IVU?
10º
(post obl) which kidney is placed in profile or II to IR and best shown?
upside
(post obl) which ureter is projected away from spine and provides unobstructed view of this ureter?
downside
which post void IVU shows nephroptosis?
erect pos
which XR shows enhanced pelvic calyceal filling?
AP IVU w ureteric compression
what pos best shows possible fistulas?
lat
a ______ obl pos shows the posterolateral aspect of bladder, especially UVJ
steeper (60º)
what should you do to show urinary reflux for AP cystogram?
center higher at level of iliac crest
1 reason for IVP?
hematuria
IVP must include?
pubic symphysis
cystograms evaluate?
bladder
VCUGs eval?
bladder + urethra
typical starting point for sthenic pt for nephrotomography?
8cm